Thursday, September 22, 2016

Learned something new. Got over another hurdle.

Two weeks ago I added another exercise into the mix. It's this guy which I hold here.

As you can see, it is an acrylic sheet with a Sharpied-in cross hair with concentric circles. It's an exercise that Tuan prescribed to me.

What I do is put it really close to my eyes to the point at which I can barely get it to come in clearly (about three to four inches). Then I close one eye and look at the target with the open eye and focus on getting it clear. Then I relax and look through the sheet and into the distance. Then I focus and get the target clear again. Then I relax and look through again. Back and forth. Again and again. Then I close that eye and open the other eye, and I alternate this exercise between the eyes.

It's an accommodation exercise (obviously), which focuses on building accommodation strength on each eye independently.

I start with this exercise for four minutes, and then continue with the fixation cards described in the previous entry for twelve minutes (I started with ten minutes, but then later intuited that another two minutes would be beneficial), then do eight minutes of Brock String. Then I do some VR games for around 20 minutes. VT takes about 30 minutes per day.

Anyway, this addition has been pretty beneficial. It seems I had plateaued and this exercise let me get over it. I was skeptical about it, because one of the things that I've always noticed is that each of my eyes works perfectly fine on its own. Accommodation, motor ability, tracking, etc. It's only when it's time to work both of them to work together that things go awry. But since I'd included this exercise I'd noticed quite a lot of improvement in all areas.

The first thing I noticed was how it had improved the fixation card exercise. It is much easier to keep the double images on top of one another as I pull the card closer and farther away. And to begin with it's easier to get the double images to (not yet quite) fuse. As I pull the card closer and farther away the double images stay together much better than ever. So that's awesome.

Also the Brock String has improved markedly. The double images of the beads are getting closer and closer together from all angles as I move the string around in a circle. I also am getting better depth with the Brock String.

As they say, you notice improvement in depth with close-up objects. This is true in my experience. I was playing Raw Data a few hours ago with the Vive and I noticed quite a lot more vividness and depth particularly when looking at my guns. Raw Data is one of the most high-quality VR games out there right now. When you look at your cyborg hands, you can very slightly squeeze the Vive's motion controllers, and you see your hands slightly move. Give it more, and you see more. Pull the trigger on the controller slightly, and the trigger on the gun pulls slowly. Move the controller around and look at it from different angles, and you can see the gun from different angles. And the gun is sort of skeletal so you can see the mechanics. It is incredibly slick, and has this tight feedback loop. It is very satisfying just to look at your guns up close, look at them from different angles, see how the light reflects off it, squeeze the trigger. And also because it's close, the effect of stereopsis is at its maximum. There is like this weird sweet spot of stimulation that Survios just nailed. Feedback, stereopsis, build-quality, light physics, etc. It's pretty incredible. Nailed it.

But yeah, enough about Raw Data. I was sort of surprised at how the addition of that exercise improved everything else. It didn't occur to me to exercise each eye independently because I was under the illusion that each eye worked fine. Because after all, I can close either eye and see everything fine. Accommodate, track, etc. What I needed was team training. But that reasoning doesn't take into account the fact that for the most part, all day, I'm using one eye. So yes, I can accommodate with each eye just fine. But maybe fine isn't good enough. That's the only explanation I can think of. It must be the case that accommodation on my left eye wasn't good enough because when I began doing this, I saw massive improvement in all areas.

It's sort of humbling. The more I learn, the more I realize I barely have a clue what the fuck I'm doing. The things I thought I knew aren't true. The more I think about this stuff, the more I realize how important good vision therapists are. How necessary and integral they are. And the less I think that doing vision therapy solo is the answer. Each time I talk to Tuan, he gives me advice and prescriptions that I find out later were exactly what I needed. And I'm wondering to myself 'How did he know that?'. The answer is probably that he's well trained and educated, worked and works his ass off, and is extremely intelligent.

Vision therapy is probably too complicated for an amateur to do it alone is where I'm starting to move. There's too much to know. And some vision therapists have just the right knowledge. They have the ability to know where you are and what is needed at that moment. And for you, that knowledge is invaluable. You haven't had hundreds of patients, and had the iterative knowledge of 'this worked for him in this situation' and 'my experience says now is the time for this'. They have the formal education of the eye and potentially a huge amount of experience in knowing how people respond to different exercises.

So that's where I'm starting to lean. And it's problematic for reasons I've talked about in other entries. How do you know who is going to be helpful? And how do you afford help from these professionals if you don't have a lot of money? Well, for the previous one you have to get their credentials. The more people they've helped achieve their goals the better. Get records of whom they've helped. Do not get a cheap but inexperienced vision therapist. Experience matters. A vision therapist is not a vision therapist is not a vision therapist.

And for the second question that's more tricky. How one affords vision therapy. Sometimes insurances covers it, sometimes not. What Tuan and I did worked very well. I got an evaluation done from a local vision therapist to get various metrics of the status of my eyes, and then he would listen to me and give me advice over Skype. Because it's remote, there's no need for an office, which saves money for him, and the talks are usually around 20 minutes. And the information got is incredibly useful. My impression is that technology is probably the answer to the problem of the cost of vision therapy, and making the knowledge and expertise of high quality vision therapists accessible.

But anyway, that was a long-ish entry, but it was something that I'd been thinking about. I don't know of anyone who's recovered stereoscopic vision via vision therapy who didn't have help, with the exception of Frederick Brock and James Blaha. I guess it has become increasingly apparent to me that I would probably be going in circles if it wasn't for an experienced and high quality vision therapist like Tuan. Thank you, Tuan.